Breaking Barriers and Building Support: Addressing the Factors That Impact Pregnant and Parenting People Who Use Drugs or Are in Recovery

The number of pregnant and parenting people who use drugs (PWUD) has increased dramatically in the past decade, in part shaped by structural inequities which further contribute to the public health crisis. Consequently, maternal and infant health outcomes–particularly for Black, Indigenous, and other people of color (BIPOC)--continue to worsen due to racialized drug policies and barriers in accessing equitable, non-punitive care. The increased burden across systems–including healthcare, child welfare, and criminal legal systems disproportionately impacts BIPOC communities.

Pregnant and parenting PWUD and those in recovery navigate micro and macro systems of oppression. Despite the need for gender-, trauma-, and culturally- responsive care, substance use disorder treatment rates remain low among pregnant and parenting individuals. Systems of surveillance and punishment continue to drive high numbers of infant removals due to prenatal substance exposure. In many states, pregnant and parenting PWUD are criminalized and prosecuted –reflecting punitive policy choices rather than public health responses. Social work (SW) as a profession has been deeply intertwined with the perpetuation of harm in systems of care. More recently, scholars addressing these issues are often at the forefront of bridging the research to policy and practice divide given SW’s focus on real world problems affecting highly marginalized populations, such as pregnant and parenting PWUD.

This roundtable includes SW scholars from four institutions across the U.S. who will discuss the micro and macro influences that impact pregnant and parenting PWUD and those in recovery, including policy, systemic, and organizational factors, and emerging interventions to support them. We will foster dialogue on overlapping and intersecting streams of research aimed at improving outcomes for pregnant and parenting PWUD and those in recovery. The first presenter will discuss the impact of policies targeting pregnant and parenting PWUD. The second will focus on how anti-Black racism operates within the carceral and recovery systems–shaping who is deemed deserving of care, who is punished, and how recovery is defined, supported, or denied. A third will discuss the current literature on the intersection of pregnant and parenting PWUD with medical and family policing systems, identifying structural inequities as well as interventions that produce healthier outcomes for mothers and their children. Two additional presenters will explore interventions that support pregnant and parenting people PWUD and those in recovery. Presenter four will emphasize the critical contributions of individuals with lived experience in enhancing support services and how states and counties can adopt targeted training models to strengthen family-centered interventions. Presenter five will describe a therapeutic parenting intervention for pregnant and parenting people with SUD and their young children developed and tested in partnership with community providers. Ideas on how to integrate this attachment-focused intervention into SUD treatment and medical settings and address challenges in research and practice will be addressed. We aim to stimulate discussion about 1) the complex challenges faced by pregnant and parenting PWUD and those in recovery and 2) how SW scholars can work to tackle the challenges at both the policy and practice levels.